In neurosurgery, the brain is treated, so the surgical approach through the sphenoid sinus of the nose is vividly called the nasal sphenoidal approach.
The nasal sphenoidal approach is definitely a minimally invasive surgery. Like other minimally invasive surgeries in neurosurgery, it uses a small opening leading to the inside of the skull.
Minimally invasive surgery has its limitations, which we have already discussed in the last case of surgery to remove parasites. After the surgical instruments are inserted through the small incision, theoretically, a roughly conical extreme surgical area will be formed through this opening. Beyond the limit area, instruments cannot reach and surgery cannot be performed.
For nasal sphenoidal approach surgery, the central area of the best surgical area is the central area where the sphenoid sinus enters. Let’s mention the sella turcica area we mentioned at the beginning again.
The surgical area that can be treated by nasal sphenoidal surgery basically revolves around the sellar area. In addition to the sellar area, some lesions near the sellar area, the suprasellar area, the parasellar area, the slope area, etc., the doctor can see with the rhinoscope and help the patient perform surgery as much as possible.
Performing the surgery through the nose does not require a craniotomy or even a hole, and leaves no scars. It definitely sounds like a better surgical approach than minimally invasive surgery. Patients definitely like this kind of surgery the most.
Not only the patients, but the doctors also like it.
What I like is not the trouble of not opening the hole, but if the doctor does not start from the nose, if the doctor wants to open the patient's skull for surgery, he can only start from the top and both sides of the head. These surgical approaches are no exception. They take a long path, pass through a lot of brain tissue, and cannot bypass the important area of the eye.
As we said before in neurosurgery, we are most afraid of inadvertently damaging other normal brain tissues and nerve blood vessels during the operation. Bypassing it if possible is the best surgical method. Therefore, three-dimensional positioning in neurosurgery has been repeatedly mentioned as the most important point.
Look at it this way, if a patient wants to undergo nasal sphenoidal surgery and the doctor wants to do it, whether it can be done depends on the patient’s condition and the patient’s luck. See if the tumor can grow enough that the surgical instruments can reach it right under the doctor's nose.
The most appropriate tumor to grow in this place would be a pituitary adenoma, because the pituitary gland is located in the sella turcica area. The best indication for nasal sphenoidal surgery is regular and long pituitary adenomas.
Another type of tumor that is more appropriate is craniopharyngioma. The craniopharyngeal duct is a structure that connects the adenohypophysis and the pharyngeal duct and later degenerates and disappears. Therefore, most of the tumors that grow here are benign tumors caused by congenital factors. It is related to the pituitary gland. Naturally, it is an operation that can be performed on the pituitary gland. As long as it is in a suitable position, it can also be performed through the transsphenoidal approach.
Since the surgical area of the transsphenoidal approach is too limited, if the tumor happens to grow just a little beyond the surgical area, what should I do if I continue to use the transsphenoidal approach? Is there a more flexible way to solve the problem?
In surgery, it is common to encounter situations where the surgical field is just a little smaller after being entered. As we have said in countless previous cases, the simplest and most effective way to expand the surgical field is to expand the incision.
The same principle applies to the nasal sphenoidal approach. To widen the sphenoid sinus is called extended sphenoid sinus incision, and the sphenoid mucosa and part of the posterior ethmoid sinus are removed.
At this point in the conversation with the patient, the people in Fangze in the next room could finally hear Dr. Tong's voice, and the people in the association pricked up their ears to listen.
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